subject: Confusion Over ADHD Behavior [print this page] Confusion Over ADHD Behavior Confusion Over ADHD Behavior
ADHD (Attention Deficit Hyperactivity Disorder) is an emotional and highly controversial topic. On this subject there is an ongoing dispute without an end in sight, where both sides of the debate have criticized the other side with emotive terms. When such a situation arises in science it is usually pointless to resort to science as the referee, as the opposing positions are based on different philosophical bases.
Both extreme sides accuse the other of being less than truthful. They use the same words, but have different meanings and connotations for these words. This article will attempt to bring a little clarity into the debate and help clean up the mess and confusion made by this academic pie fight.
There are researchers in the middle ground between the extremes who are changing the paradigm of what ADHD is and how it can be treated for lasting results. We do not hear much about these people through the noise of those on the extreme ends of the ADHD debates.
The word that causes most confusion is the word "disorder" which is either considered a disorder as in sick and disease, or that the use of "disorder" is a fraud, used as an attempt to control active children in the classroom. Other ideas, such as that the "disorder" is an invention of the pharmaceutical companies to boost drug sales are also floating around. No wonder people on the sidelines are confused.
Most of the confusion would be removed if a distinction were made between a set of behaviors, which are a set of symptoms, and a disorder. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) diagnosis for ADHD lists a series of behaviors. If there is a disorder, then this disorder is the cause, or the reason, for the behavior. Frustration is not a disorder, but is one of over 100 causes of ADHD like behavior. If a child is hyperactive because of frustration, then there is no disorder. If the child has an over- or underproductive thyroid, then the disorder is the thyroid gland and not an "inherited neurobiological mental illness."
This emotionally driven fuzzy science has led to ADHD being the most over diagnosed, the most under diagnosed and the most misdiagnosed children's condition, all at the same time. The official diagnosis is 15 to 20 years out of date. There have been great advances in our understanding of what ADHD is over the last 5 to 8 years, but they have not been incorporated into the diagnosis. In fact the latest research findings are being interpreted by this outdated diagnosis. The main weakness for this outdated diagnosis is that the assessments are based on subjective attitudes and not on objective tests. The DSM-IV manual (the official diagnostic tool) makes this clear:
"There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder." (DSM-IV, page 88)
This statement is till valid today. The next DSM, the DSM-V is due to be published in the spring of 2012, and hopefully that will clarify some of today's misunderstandings.
There are three logical explanations for the use of the term "disorder:"
It is an historical artefact of the terminology used for 100 years.
The term is used for health insurance purposes, so that children with these behavior patterns can be legally protected during their education, receiving special help and not be discriminated against.
The DSM-IV committee had difficulty with the term and decided this term, disorder, was a compromise.
"The problem raised by the term mental disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute ... Mental disorders have also been defined by a variety of concepts (e.g., distress, dysfunction, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndromal pattern, etiology and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, and different situations call for different definitions."
(DSM-IV Introduction page xxxi)
The most serious error in the Attention Deficit debate is the diagnosis being anchored in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) without any physiological test or neurological criteria. This is not science; this is a cultural attitude. The DSM-IV diagnostic criteria for ADHD are guidelines and not hard rules.
The DSM-IV age criteria, which should be met, as an example, that children should be diagnosed before the age of 7, is arbitrary and has no scientific base as children's behavior at this age is still developing. In fact from a scientific perspective it confuses the issue. There are more adults with Attention Deficit than there are children with it. Most of these adults were not diagnosed as children or adolescents, let alone before the age seven. In the United States there is an estimated 8 million adults with Attention Deficit.
I was diagnosed at 58. I remember ADD symptoms in my teen years, but have no recollections of my ADD behavior before the age of seven. The Inattentive type of ADHD is unlikely to be noticed until after 7 years of age.
There is hysteria in some areas of the United States, where children are forced to take stimulant medication by schools. The same schools who pride themselves with being "drug free zones." The child welfare authorities in some areas are even threatening parents, if their children do not get medication.
This same stimulant medication, if sold in the local park or school corridor, would lead to a jail sentence for narcotics possession. When I was a teen this was one of the popular illegal drugs of choice. Surely there must be a healthier way to deal with the problem, especially with the side effects many experience.
There is a place for medication, but the medications used for ADHD are powerful drugs that do not cure, they merely suppress symptoms for some hours. This is useful if the ADHD is so intense that it is not possible to benefit from coaching, therapy or brain gym. The medication can then legitimately and ethically be use to quiet the mind. The lasting cure is through the coaching, therapy, diet and brain exercises. There is no universal cure. ADHD is complex and which combination of treatments and/or strategies is individual.
The long-term effects of these drugs are unknown. Clinical trials last a few months. There is nobody who knows the result of continuous use over a lifetime for a specific individual. Surely the answer sought should be a permanent solution.
Being ignorant of my condition, yet understanding that I was not like others, I learned coping skills. My self-medication was strong coffee and green tea. My experiments with amphetamines did not impress me. I did not know they were supposed to help me feel "normal." What I do remember is losing the following day sleeping it off.
It might be a disorder of western society if a recently published research paper is anything to go by. Researchers studied a population in Northern Kenya. There were two groups, both belonging to the same tribe. The one lived a settled semi urban lifestyle and the second group continued the traditional nomadic lifestyle of the tribe. The Attention Deficit individuals in the sedentary group had emotional problems and a shorter life span than their nomadic relatives. The conclusion was that a nomadic lifestyle suits the ADHD personality.
ADHD need not be a curse. For many it can be a gift. To bring out the full potential of the gift, three steps are needed, to educate, to empower and to energize.
Understanding what ADHD is, what causes ADHD and how it can be cured are the educational pillars on which our ADHD programs should stand.
As we learn about our own individual ADHD, we begin to identify our symptoms, and how we respond with behavior and attitudes. As we learn to manage our ADHD symptoms we are empowered. Learning to use strategies, tools and coping skills, we can take advantage of our strengths and compensate for our weaknesses. These are all part of the empowering process.
As these tools and skills become second nature, confidence and self esteem develop to energize us to improve even more.
ADHD is very individual. The combination of symptoms varies, as does the intensity of the symptoms. What is an ideal solution for one person is not necessarily right for another person. For a lifelong solution some form of ADHD coaching, Cognitive Behavioral Therapy, or Brain Exercise Therapy is required.
If your young child is showing some signs and symptoms of ADHD, then take action according to the behavior. A six to eight year old child is difficult to diagnose with ADHD. There are reliable strategies, tools and coping skills, which should be the first steps to reduce family stress. Then methods and strategies to develop and strengthen the child's mind can be put into place.
A serious and responsible ADHD coach will be a good guide to choosing the correct therapy, both for children and adults. Most ADHD coaches have ADHD themselves. They were helped so much by being coached, that they have gone through coaching training, to make a career of helping others.
There are over 100 disorders and conditions, both psychological and physiological, which result in attention deficit and/or hyperactive behavior. Here the actual cause of the disorder needs to treated rather than focussing on the behavior. Medicating these children suppress the symptoms leaving the disorder untreated.
True ADHD is a part of the diversity within humanity. It is found in all races, cultures and nations. It was there long before the disorder was described in a scientific journal. Much of the disorder problem would go away if it were considered as a personality type rather than a disorder. A personality type never excuses bad behavior, but how to teach a child to behave would be easier with a different attitude. To be able to guide a child to cope with ADHD is an empowering experience for both the child and the parent.
The positive sides of this personality are an innate creativity, energy, ingenuity and a hyper focused attention when active with something stimulating. Many leading entrepreneurs, such as Sir Richard Branson, are successful, not despite, but because of their ADHD. It is very likely that Aristotle had ADHD. Other famous people with behavior that indicate ADHD were Galileo, Leonardo da Vinci, Isaac Newton, Albert Einstein, Picasso and the actors Robin Williams and Whoopi Goldberg. A long list of people with ADHD have benefited humanity and brought us to where we are today in fields as varied as science, technology, economics, mathematics and the arts.
